We are proposing a 5-year study to understand the prevalence and pathophysiology of hearing impairment in HIV-infected men and women, including the effect of long-term antiretroviral therapy. We plan to examine the hypothesis that individuals infected with HIV experience auditory dysfunction and that this impairment may be associated with disease stage and long- term use of antiretroviral therapy. We will examine the following specific aims: 1. Assess the prevalence and types of hearing impairment in individuals infected with HIV-1 compared to uninfected controls and define the effects of aging on auditory function in these groups. We hypothesize that individuals infected with HIV-1 will experience auditory dysfunction. HIV-1 may cause a direct effect on the cochlea, eight nerve or central auditory system. We anticipate that HIV-1 infected patients may have impairment of auditory function earlier in life compared to uninfected controls. 2. Determine the influence of HIV-1 disease stage on auditory impairment in HIV-1 infected individuals. We hypothesize that hearing impairment will be more prevalent among HIV-1 infected individuals at advanced stages of HIV disease compared to individuals at earlier stages of the disease. We expect that individuals with symptomatic HIV-1 infection without virologic suppression will have worse auditory function than patients with sustained virologic control. 3. Determine the influence of antiretroviral medications on hearing function. We hypothesize that long-term use of antiretroviral medications affects hearing, possibly through mitochondrial toxicity and changes in the oxidative process, which may be similar, in some ways, to the negative effects of diabetes on the auditory system. In general, hearing impairment is associated with a decreased economic productivity, decreased quality of life, depression, reduced functional status and social isolation. Preserving communicational status and social interactions are crucial for productivity in the work force and personal well being. In addition, hearing impairment may prevent verbal communication with health care providers, interfere with understanding and compliance for medical recommendations and hinder adherence to medications crucial to successful treatment of HIV/AIDS. PUBLIC HEALTH RELEVANCE: Hearing impairment is associated with a decreased economic productivity, decreased quality of life, depression, reduced functional status and social isolation. Preserving communicational status and social interactions are crucial for productivity in the work force and personal well being. In addition, hearing impairment may prevent verbal communication with health care providers, interfere with understanding and compliance for medical recommendations and hinder adherence to medications crucial to successful treatment of HIV/AIDS.